The newer body-identical micronised progesterone may cause somnolence. Women with hot flushes treated with menopausal hormone therapy ( MHT) show a marked improvement in sleep quality (4). The use of oestrogen, alone or in combination with a progestogen, has been shown to improve the subjective quality of sleep (8-11).regular schedules, sleep hygiene, elimination of caffeine and alcohol, appropriate and comfortable bedding and temperatures as well as sleep hygiene should be employed (1). (Please refer to AMS Information Sheet Lifestyle and behavioural modifications for menopausal symptoms). Strategies may include medications and lifestyle and behavioural modification (1).Formulating a strategy is dependent on a thorough investigation and evaluation of all contributing factors (1).It is a useful test for the evaluation of patients describing excessive daytime sleepiness in the absence of causes such as sleep apnoea, sleep loss or certain medication usage. Multiple Sleep Latency Tests (MSLT) is a specialised test measuring the time taken to fall asleep over 4 nap opportunities during the day in a controlled laboratory setting.Respiratory monitoring and leg EMG (to assess disordered breathing or periodic leg movement disorder). ![]() Continuous EEG recording will assess the various sleep stages.Overnight polysomnography (PSG) (to assess for breathing disorders, movement and circadian rhythm disorders).Tests available during a specialist sleep consultation may include (1):.This may also be used to assess the response to therapy. Wrist actigraphy (to assess sleeping patterns and awakenings on consecutive nights and to provide information on certain sleep disorders, including shift work disorder).Objective assessment measures of sleep disturbance may include (1):.However, there are discrepancies between the objective and subjective measures, putting the role of laboratory assessments into question (1). Self-reported questionnaires (a sleep diary to assess issues related to sleep hygiene, duration of sleep and circadian rhythm), may provide information regarding perceived sleep quality.The STOP Bang questionnaire (7) is a useful screening questionnaire for snoring and obstructive sleep apnoea. The Pittsburgh Sleep Quality Index (5) (measures sleep quality) and Epworth Sleepiness Score (6) (assesses the degree of sleepiness) may be useful tools.Take a thorough history, including the type of sleep disturbances, co-morbid conditions, contributing factors, medications and impact on quality of life (1).Sleep difficulties are more common in post-menopausal than in pre-menopausal women, and more severe in those experiencing a surgical menopause (4). It has been noted that insomnia is more common in women than in men, with 25% of women between the ages of 50- and 64-years having sleep difficulties.Lifestyle factors (poor sleep hygiene, irregular schedules, caffeine, alcohol, snoring partner).Co-morbid conditions (snoring, airway obstruction, restless legs syndrome, periodic limb movement disorder, musculoskeletal pain and fibromyalgia).Vasomotor symptoms (sweating and flushing), mood disorders (depression and anxiety).Changing hormone levels (hormones playing a role in sleep include growth hormone, prolactin, cortisol and melatonin).Sleep duration of less than seven hours a night has been associated with increased mortality (2), as well as linked to cardiovascular disease, obesity, mood disorders and diabetes (3, 4). Complaints about poor sleep include difficulty falling and staying asleep, coupled with early morning and nocturnal awakenings (1). ![]() Many women complain of disturbed sleep during the peri-menopause and after menopause.
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